Pediatric liver transplantation in Latin America: Where do we stand?

LT started in LA in 1968, and pediatric LT records are available starting in the 1990s. Currently, eight countries perform pediatric LT in LA. Registries by national organizations fail to report robust data on pediatric LT. The aim of this paper was to report on the pediatric LT activity in LA. Data were gathered retrospectively through information available in the national registries websites and from local centers. Of the eight countries that report pediatric LT activity, Brazil, Argentina, Mexico, and Colombia have adequate registries of the numbers of LT performed. These countries concentrate most of the activity for pediatric LT. A total of 4593 pediatric LT were reported in LA. Websites for national organizations do not provide open data on post-transplant survival rates or waiting list mortality. The information herein is based on reports by local centers. Overall, survival from select centers is similar to that reported on North American and European registries, between 80 and 90% in the first year post-transplant. In conclusion, pediatric LT activity is growing in LA, especially in Brazil and Argentina. However, the lack of an appropriate LA registry restricts the assessment of quality and therefore restricts interventions aimed at quality improvements in different regions.

Intraocular pressure control after the implantation of a second Ahmed glaucoma valve.

The objective of this study is to evaluate the efficacy and safety of a second Ahmed glaucoma valve (AGV) in eyes with refractory glaucoma that had undergone prior Ahmed device implantation. This multicenter, retrospective study evaluated 58 eyes (58 patients) that underwent a second AGV (model S2-n = 50, model FP7-n = 8) due to uncontrolled IOP under maximal medical therapy. Outcome measures included IOP, visual acuity, number of glaucoma medications, and postoperative complications. Success was defined as IOP <21 mmHg (criterion 1) or 30 % reduction of IOP (criterion 2) with or without hypotensive medications. Persistent hypotony (IOP <5 mmHg after 3 months of follow-up), loss of light perception, and reintervention for IOP control were defined as failure. Mean preoperative IOP and mean IOPs at 12 and 30 months were 27.55 ± 1.16 mmHg (n = 58), 14.45 ± 0.83 mmHg (n = 42), and 14.81 ± 0.87 mmHg (n = 16), respectively. The mean numbers of glaucoma medications preoperatively at 12 and 30 months were 3.17 ± 0.16 (n = 58), 1.81 ± 0.2 (n = 42), and 1.83 ± 0.35 (n = 18), respectively. The reductions in mean IOP and number of medications were statistically significant at all time intervals (P < 0.001). According to criterion 1, Kaplan-Meier survival curves disclosed success rates of 62.9 % at 12 months and 56.6 % at 30 months. According to criterion 2, Kaplan-Meier survival curves disclosed success rates of 43.9 % at 12 months and 32.9 % at 30 months. The most frequent early complication was hypertensive phase (10.3 %) and the most frequent late complication was corneal edema (17.2 %). Second AGV implantation may effectively reduce IOP in eyes with uncontrolled glaucoma, and is associated with relatively few complications.

Study of the effect of distance and misalignment between magnetically coupled coils for wireless power transfer in intraocular pressure measurement.

An analysis of the effect of distance and alignment between two magnetically coupled coils for wireless power transfer in intraocular pressure measurement is presented. For measurement purposes, a system was fabricated consisting of an external device, which is a Maxwell-Wien bridge circuit variation, in charge of transferring energy to a biomedical implant and reading data from it. The biomedical implant is an RLC tank circuit, encapsulated by a polyimide coating. Power transfer was done by magnetic induction coupling method, by placing one of the inductors of the Maxwell-Wien bridge circuit and the inductor of the implant in close proximity. The Maxwell-Wien bridge circuit was biased with a 10 MHz sinusoidal signal. The analysis presented in this paper proves that wireless transmission of power for intraocular pressure measurement is feasible with the measurement system proposed. In order to have a proper inductive coupling link, special care must be taken when placing the two coils in proximity to avoid misalignment between them.

Liver transplantation for autoimmune hepatitis in Peru: outcomes and recurrence.

BACKGROUND: Liver transplantation is the only therapy for end-stage liver disease. Cirrhosis secondary to autoimmune hepatitis (AIH) is an indication in 4-6% of adult transplants. AIMS: To describe the outcomes and recurrence of AIH in liver transplant patients. MATERIAL AND METHODS: Twenty patients were retrospectively studied. RESULTS: The female/male ratio was 3:1, the median age was 36.7 years (range, 16 to 39 years), and the median MELD score was 18.5. According to serological analysis, 19 patients were AIH type 1 and one patient was AIH type 2. AIH was associated with human leukocyte antigen (HLA) DR13+ and DR4+. The overall 5-year patient and graft survival rates were 94 and 85%, respectively. Three (15.7%) cases of recurrent AIH were diagnosed based on histological evidence. Clinical and histological features of acute and chronic rejection were present in four (20%) and three (16.6%) patients, respectively. CONCLUSION: AIH frequently affected young women, was the most frequent indication for liver transplantation. Rejection and recurrence were commonly associated with AIH, but did not affect patient survival. No significant relationship between HLA-DR type and recurrence was found. Rapid progression to cirrhosis should be considered in severe recurrences.

Improvement of the Thermal Stability of Polymer Bioblends by Means of Reactive Extrusion.

Poly(lactic acid) (PLA) and biosourced polyamide (PA) bioblends, with a variable PA weight content of 10-50%, were manufactured by melt blending in order to improve the behavior of PLA against thermal degradation. The effect of reactive extrusion on the thermal performance of PLA within bioblends was analyzed. The reactive extrusion was made by means of the addition of a styrene-acrylic multi-functional-epoxide oligomeric reactive agent (SAmfE), with the commercial name of Joncryl. Four parameters were considered in order to study the thermal behavior of bioblends against thermal decomposition: the onset decomposition temperature, the shape and temperature interval of the thermal decomposition patterns, the activation energy of the thermal decomposition, and the evidence leading to the most probable mechanism. The latter was determined by means of three evidence: standardized conversion functions, y(α) master plots, and integral mean error. It was shown that reactive extrusion of PLA as well as PA incorporation to the polymer matrix of PLA were responsible for an increase in the onset decomposition temperature of 10.4 °C. The general analytical equation (GAE) was used to evaluate the kinetic parameters of the thermal degradation of PLA within bioblends for various reaction mechanisms. It was shown that the random scission of macromolecular chains is the best mechanism for both untreated and treated PLA by means of reactive extrusion. It was shown that reactive extrusion together with higher content of PA resulted in an increased protective effect against the thermal degradation of PLA as demonstrated by an increase in activation energy of 60 kJ/mol. It was found that there is a relationship between the increase in activation energy and the increase in the onset decomposition temperature when using reactive extrusion. The improvement of the thermal stability of bioblends by means of reactive extrusion was explained by an increase in the complex viscosity from 980 to 2000 Pa·s at 0.06 rad/s and from 250 to 300 Pa·s at 630 rad/s for bioblend containing 30% of PLAREX and by a finer dispersion of PA within the PLAREX matrix. Results from DSC were not conclusive regarding the compatibility between both phases.

Effective Tensile Strength Estimation of Natural Fibers through Micromechanical Models: The Case of Henequen Fiber Reinforced-PP Composites.

The performance of henequen fibers and polypropylene composites obtained by injection molding with and without coupling agent was evaluated. Henequen fibers are natural non-wood fibers mainly used in textile sector or in thermosetting matrix composites. In this work, henequen fibers have been used as a possible substitute reinforcement material for sized glass fibers. The surface charge density of the materials used was evaluated, as well as the morphology of the fibers inside the material. A significant reduction in the length of the fibers was observed as a consequence of the processing. The use of a 4% coupling agent based on fiber content was found to be effective in achieving significant improvements in the tensile strength of the composites in the reinforcement range studied. The influence of the aspect ratio on the coupling factor was determined, as well as the evaluation of the interface quality. The results obtained demonstrate the great potential of henequen fibers as reinforcement of composite materials, giving rise to strong interfaces with coupling. Finally, the comparison of henequen fiber composites with sized glass fiber composites showed that it is possible to substitute polypropylene composites with 20 wt.% glass fiber for 50 wt.% henequen fibers.

Implications of the Circular Economy in the Context of Plastic Recycling: The Case Study of Opaque PET.

The use of recycled opaque PET (r-O-PET, with TiO2) as a reinforcement for the recycled polypropylene matrix (r-PP) was evaluated through the life cycle assessment according to different scenarios corresponding to two different recycled blends and considered two virgin raw plastic material as reference materials when comparing the environmental performance of the proposed treatments. The results indicate that the environmental performance was quite different for each blend, since the additional extrusion process required in scenario 2 (blend with TiO2) causes all impact categories analysed to report higher values when compared with scenario 1 (blend without TiO2). The stage that contributes the most corresponds to the different extrusion processes included in both recycling blends, representing at least 80% of the total for global warming. Compared with virgin raw materials, the blend with TiO2 showed better performance in all the impact categories analysed in comparison with virgin PA66, while the blend without TiO2 showed the opposite trend when compared to PP. Furthermore, the fact that the upcycling treatment was carried out on a pilot scale provides room for improvement when implemented on a full scale. It is worth noting the high energy consumption of the treatment processes and their associated cost, in addition to the market cost of virgin raw materials, however, when considering the environmental cost of raw materials, it is observed that when substituting virgin materials PP and PA66 for the blends evaluated in this study results in a reduction of the environmental price of up to 2.5 times.

Kinetics of the Thermal Degradation of Poly(lactic acid) and Polyamide Bioblends.

Poly(lactic acid) (PLA) and biosourced polyamide (PA) bioblends, with a variable PA weight content of 10-50%, were prepared by melt blending in order to overcome the high brittleness of PLA. During processing, the properties of the melt were stabilized and enhanced by the addition of a styrene-acrylic multi-functional-epoxide oligomeric reactive agent (SAmfE). The general analytical equation (GAE) was used to evaluate the kinetic parameters of the thermal degradation of PLA within bioblends. Various empirical and theoretical solid-state mechanisms were tested to find the best kinetic model. In order to study the effect of PA on the PLA matrix, only the first stage of the thermal degradation was taken into consideration in the kinetic analysis (α < 0.4). On the other hand, standardized conversion functions were evaluated. Given that it is not easy to visualize the best accordance between experimental and theoretical values of standardized conversion functions, an index, based on the integral mean error, was evaluated to quantitatively support our findings relative to the best reaction mechanism. It was demonstrated that the most probable mechanism for the thermal degradation of PLA is the random scission of macromolecular chains. Moreover, y(α) master plots, which are independent of activation energy values, were used to confirm that the selected reaction mechanism was the most adequate. Activation energy values were calculated as a function of PA content. Moreover, the onset thermal stability of PLA was also determined.

Pediatric Kidney Transplantation in Perú: A Single-Center Initial Experience.

BACKGROUND: Pediatric kidney transplantation (PKTx) is the preferred therapy for children with end-stage renal disease (ESRD) worldwide. Regrettably, in Perú, access to PKTx is extremely difficult due to recipient/donor socio-economic status, health care structure and especially, scarcity of organs. Our center (the only pediatric institute in the country) has recently started a PKTx program with good midterm results. The aim of this study was to present our outcomes. METHODS: Retrospective analysis of prospectively collected data between December 2017 and August 2019. Fourteen PKTx (< 18 years old) were achieved. As per our protocol: pre-implantation/protocol biopsies, antibody assessment (T/B cell flow cytometric plus HLA testing applying polymerase chain reaction-based technology), triple immunosuppression (tacrolimus, mycophenolate mofetil, steroids) and induction therapy was performed in every case. RESULTS: The recipient's mean age at the time of PKTx was 14.14 ± 2.62, 8/14 (57.14%) were male, 50% developed ESRD due to undetermined etiology, 11/14 (78.57%) received a deceased donor allograft, and 9/14 (64.28%) required induction with thymoglobulin. Postoperative complications included: delayed graft function (1/14, 7.14%), 1 (7.14%) developed gross hematuria associated with allograft disfunction post-protocol allograft biopsy that was managed conservatively and 1 recipient (7.14%) developed grade II oligoastrocytoma, at 10 months post PKTx. CONCLUSIONS: PKTx is the best therapeutic option for children with ESRD. Our group demonstrated that even in countries with limited resources like Perú, good midterm results can be achieved. Emphasis should be given to improve access to transplantation especially in the setting of pediatric recipients.

The efficacy and safety of two fixed combinations: timolol-dorzolamide-brimonidine versus timolol-dorzolamide. A prospective, randomized, double-masked, multi-center, 6-month clinical trial.

We compared the efficacy and safety of a new fixed combination of timolol 0.5%/odorzolamide 20%/brimonidine 0.2% in ophthalmic solution versus a fixed combination of timolol 0.5%/dorzolamide 2% in patients with open-angle glaucoma or ocular hypertension. The fixed triple combination was significantly more efficient in mean intraocular pressure reduction from baseline throughout the six-month follow-up.

PLA/PA Bio-Blends: Induced Morphology by Extrusion.

The effect of processing conditions on the final morphology of Poly(Lactic Acid) (PLA) with bio-based Polyamide 10.10 (PA) 70/30 blends is analyzed in this paper. Two types of PLA were used: Commercial (neat PLA) and a rheologically modified PLA (PLAREx), with higher melt elasticity produced by reactive extrusion. To evaluate the ability of in situ micro-fibrillation (f) of PA phase during blend compounding by twin-screw extrusion, two processing parameters were varied: i) Screw speed rotation (rpm); and ii) take-up velocity, to induce a hot stretching with different Draw Ratios (DR). The potential ability of PA-f in both bio-blends was evaluated by the viscosity (p) and elasticity (k') ratios determined from the rheological tests of pristine polymers. When PLAREx was used, the requirements for PA-f was fulfilled in the shear rate range observed at the extrusion die. Scanning electron microscopy (SEM) observations revealed that, unlike neat PLA, PLAREx promoted PA-f without hot stretching and the aspect ratio increased as DR increased. For neat PLA-based blends, PA-f was promoted during the hot stretching stage. DMTA analysis revealed that the use of PLAREx PLAREx resulted in a better mechanical performance in the rubbery region (T > Tg PLA-phase) due to the PA-f morphology obtained.

Management Of Glaucoma In Developing Countries: Challenges And Opportunities For Improvement.

Glaucoma is the leading cause of blindness in the developed and developing world. Not only is the clinical impact of this disease considerable, but associated economic and humanistic burdens - affecting patients, caregivers, and society - are substantial. Since glaucoma is an age-related disorder and populations in many developing countries are aging at a faster pace than in the developed world, increasing attention is being focused on ways to ameliorate the burdens of illness. In this paper, we examine the burdens of glaucoma with particular focus on developing countries, discuss some of the challenges that exist in delivering optimal glaucoma management within budget constraints, and bring into perspective how we could improve current healthcare systems, leverage technology, and strike an appropriate balance between cost and quality of care, thereby offering considerations to payors and policymakers in these countries that may result in longer-term cost savings, while concurrently striving to achieve the WHO Vision on the prevention of blindness and visual impairment.

Experiencias de personas adultas con discapacidad intelectual sobre el derecho a la vida independiente: Un estudio de caso / Experiences of adults with intellectual disabilities on the right to independent living: A case study

Resumen En el ámbito de la discapacidad intelectual, el desarrollo de una vida independiente se ha configurado como un derecho humano y civil que permite a estas personas articular planes de vida deseados. Esta investigación analiza, mediante un estudio de caso, los significados que un grupo asesor compuesto por ocho personas adultas con discapacidad intelectual tiene sobre el concepto de vida independiente en el contexto chileno. Para la recopilación de los datos se diseñó una entrevista grupal semiestructurada acompañada de moodboards que facilitaron la verbalización de las respuestas. Sobre los relatos obtenidos a partir de las entrevistas se realizó un análisis de contenido temático. Los resultados muestran cómo el desempeño de una actividad laboral remunerada o el establecimiento de relaciones afectivas sólidas se conforman como elementos imprescindibles para la independencia personal. La dificultad para ser económicamente independientes o la falta de accesibilidad en el entorno laboral se identifican también como principales barreras para la concreción de este derecho. Igualmente, se destaca el rol que desempeñan la pareja y las amistades como figuras de apoyo constante a la independencia y al empoderamiento personal. Estos resultados sugieren algunas orientaciones para la planificación de intervenciones sobre este constructo, las cuales deben procurar la adquisición de habilidades que fortalezcan la capacidad de autocuidado de este colectivo, promover el incremento de oportunidades para la realización de elecciones significativas en el ámbito laboral, personal y comunitario, y adaptarse a los espacios en los que se desenvuelven las personas con discapacidad intelectual en la edad adulta.

Abstract In the field of intellectual disability, the development of an independent life has been configured as a human and civil right that allows these people to articulate desired life plans. Despite the advances, at the international level, research on aspects related to independent living in people with intellectual disabilities continues to be very scarce. Generally, the approaches to the study of this construct are based on broader investigations dedicated to evaluating the levels of quality of life or self-determination of this population in residential services or sheltered housing. Precisely, this study analyzes, through a case study, the meanings that an advisory group made up of eight adults with intellectual disabilities has on the concept of independent living in the Chilean context in order, on the one hand, to identify relevant elements for the definition of the construct from the perceptions and experiences of this population; and on the other, to propose guidelines at various levels that allow progress in the realization of this right. To collect the data, a semi-structured group interview was designed whose questions were grouped around four themes: previous conceptions of the participants about the construct of independent life, satisfaction with life and possibilities of the context for the development of personal independence, role of family, friendship and partner in independent life, and opportunities of the work context for the achievement of personal independence. During the interview, another strategy was incorporated in which visual language gained more relevance. Specifically, a set of ten moodboards were used that allowed participants to delve into the different topics addressed. The results of the code validation process were calculated using Krippendorff's alpha statistics (.954) and Cohen's kappa (.953), which showed a high level of inter-judge agreement. As a result of this process, categories (N = 6) and subcategories (N = 17) were established. The results show how various needs, barriers and facilitators for the development of independent life are identified from the interviews of the interviewees. Among the main needs is the performance of a paid work activity or the establishment of solid affective relationships. With regard to the barriers that hinder personal independence, the most notorious are related to the difficulty of being financially independent or to the lack of accessibility in the work environment. Regarding the elements that facilitate the development of an independent life, the role of the couple stands out as a constant figure of support for independence and personal empowerment. These results suggest some guidelines for planning interventions on this construct. Among others, they should seek the acquisition of skills that strengthen the self-care capacity of this group; should promote increased opportunities for making meaningful choices in the workplace, personal and community; and they must adapt to the spaces in which people with intellectual disabilities operate in adulthood. On the other hand, it is assumed that one of the main limitations of this research is that the results are not generalizable. However, this study has some strengths. Among others, it contributes to enriching the bulk of research on independent living, this being an aspect barely addressed in the literature. It also complements the results of other research regarding the elements that can condition the development of skills for personal independence. This allows for the design of interventions that provide opportunities for independent living based on the felt needs of these people. In addition, it raises future lines of research related, for example, to the importance of the informed choice of the residential environment or to the study of the possibilities of the digital world as an incident phenomenon in the acquisition of skills for personal independence.

Pancreatoduodenectomía laparoscópica híbrida: resultado en paciente obeso con adenocarcinoma duodenal

La cirugía pancreática mínimamente invasiva sigue ampliando sus indicaciones de manera lenta pero constante. Su aplicación en pacientes obesos y/o con neoplasias periampulares es controversial por la elevada tasa de complicaciones reportada en esta población. Presentamos un paciente de sexo masculino de 62 años, obeso (IMC 35,4 Kg/m2), hipertenso y diabético que desarrolla anemia severa (Hb = 4,9 g/dl) por adenocarcinoma de segunda porción duodenal. El estadiaje por imágenes verifica enfermedad localizada. El paciente fue sometido a pancreatoduodenectomia híbrida (resección laparoscópica/reconstrucción abierta por minilaparotomía). Se describe técnica operatoria y evolución postoperatoria. El paciente cursó sin complicaciones mayores (pancreatitis aguda moderada), el tiempo operatorio fue 540 minutos, el volumen de sangrado 400 ml, requirió la transfusión de 1 unidad de paquete globular y estancia de 8 días. No tuvo intercurrencias durante 90 días después de la cirugía. Se concluye que la pancreatoduodenectomía híbrida es una alternativa factible y segura en pacientes obesos con adenocarcinoma duodenal, ofrece ventajas en la reducción del trauma quirúrgico.

Minimally invasive pancreatic surgery has expanded slowly but steadily. The application of this approach in obese patients and/or with periampullary neoplasms is still controversial because of the high complication rate in this group of patients. We present the case of a 62-year-old male, obese (BMI 35.4 Kg/m2), hypertensive and diabetic, who developed severe anemia (Hb 4.9 g/dl) due to duodenal adenocarcinoma. Imaging staging verified localized disease. The patient underwent Hybrid Pancreatoduodenectomy (laparoscopic resection/open minilaparotomy reconstruction). The operative technique and postoperative course are described. The patient had no major complications (moderate acute pancreatitis), the operative time was 540 minutes, the bleeding volume was 400 ml, he required transfusion of 1 unit of globular package and a stay of 8 days. He had no intercurrences during 90 days after surgery. It is concluded that hybrid pancreatoduodenectomy is a feasible and safe alternative in obese patients with duodenal adenocarcinoma, offering advantages in reducing surgical trauma.

Transpalpebral Electrical Stimulation as a Novel Therapeutic Approach to Decrease Intraocular Pressure for Open-Angle Glaucoma: A Pilot Study.

PURPOSE: To determine the effect on intraocular pressure of transpalpebral specific exogenous voltages in a cohort of open-angle glaucoma patients. METHODS: This is a prospective, comparative, and experimental pilot study. The electrical stimuli applied consisted of 10 Hz, biphasic, nonrectangular current pulses (100 µA) delivered from an isolated constant current stimulator. At intake, baseline IOP measurements were obtained from each eye. The measurement was repeated before and after microstimulation until the end of the treatment. RESULTS: Seventy-eight eyes of 46 patients diagnosed with POAG were studied: 58 eyes with maximum tolerated medical treatment and 20 eyes without treatment (naïve). The mean baseline IOP on the treated POAG group was 19.25 mmHg ± 4.71. Baseline IOP on the naïve group was 20.38 mmHg ± 3.28. At the four-month follow-up visit, the mean IOP value on the treatment group was 14.41 mmHg ± 2.06 (P < 0.0001). The obtained mean IOP measurement on the treatment-naïve group was 15.29 mmHg ± 2.28 (P < 0.0001). CONCLUSIONS: The hypotensive response obtained using transpalpebral electrical stimulation on POAG patients, both on treatment-naïve patients and on patients receiving maximum tolerable treatment, was statistically significant when comparing basal IOP measurements to those obtained at the four-month follow-up visit.

A 6-week, multicenter, randomized, double-masked, parallel-group study comparing travoprost 0.004% to latanoprost 0.005% followed by 6-week, open-label treatment with travoprost 0.004%.

OBJECTIVE: The aim of this study was to compare the tolerability and efficacy of once-daily travoprost 0.004% versus latanoprost 0.005% for 6 weeks followed by 6 weeks of once-daily travoprost 0.004% in decreasing intraocular pressure (IOP) in patients with open-angle glaucoma (OAG) or ocular hypertension (OH). METHODS: This multicenter, randomized, doublemasked, active-controlled, parallel-group trial was conducted at 32 centers across Latin America. Patients aged > or =18 years with OAG or OH were randomly assigned to receive topical travoprost 0.004% or latanoprost 0.005% 1 drop QD (9 PM) for 6 weeks (masked phase). At 6 weeks, all patients were assigned to receive open-label travoprost 0.004% 1 drop QD (9 PM) for 6 additional weeks (open-label phase). Study visits were scheduled at weeks 1, 2, 4, 6, 8, and 12. At each study visit, IOP was measured at 5 PM (+/-1 hour; approximately 20 hours after study drug administration). IOP changes from baseline were combined (pooled) from the 1-, 2-, 4-, and 6-week data to provide a comparison between the 2 treatment groups. Ocular adverse events (AEs) were monitored using slit-lamp examination. RESULTS: A total of 302 patients were enrolled (travoprost group, 155 patients; latanoprost group, 147 patients). The mean (SD) age of the travoprost group was 61.9 (10.6) years; 60.6% were female; and 47.1% were white. The mean (SD) age of the latanoprost group was 60.5 (12.4) years; 62.6% were female; and 49.0% were white. Mean IOP values were not significantly different between the travoprost and latanoprost groups at baseline (24.7 vs 24.2 mm Hg) or 6 weeks; however, the between-group difference in reductions from baseline in pooled IOP during the masked phase of the study was statistically significant (-8.3 vs -7.5 mm Hg; P = 0.009). At weeks 6 and 12, mean lOP levels were 16.1 and 16.2 mm Hg, respectively, in the travoprost group and 16.4 and 16.1 mm Hg in the group that was switched from latanoprost to travoprost (all, P = NS). The most common ocular AEs that occurred with masked travoprost, latanoprost, and open-label travoprost were hyperemia (26.9%, 12.2%, and 5.3%, respectively), discomfort (3.2%, 3.4%, and 1.1%), and pruritus (4.5%, 2.0%, and 2.1%). CONCLUSIONS: In this population of patients with OAG or OH, 6-week treatment with travoprost 0.004% was associated with a significantly greater decrease from baseline in pooled IOP compared with latanoprost 0.005% 20 hours after administration. There were no significant differences between the 2 groups. Travoprost and latanoprost were well tolerated.

Effects of topical travoprost 0.004% on intraocular pressure and corneal biomechanical properties in an animal model.

PURPOSE: To determine whether topical application of travoprost 0.004% induces changes in corneal biomechanical properties affecting intraocular pressure (IOP) values in rabbits. METHODS: Both eyes of 10 New Zealand rabbits were measured 3 times with the Ocular Response Analyzer (ORA) before treatment. Each measurement included corneal hysteresis (CH), corneal resistance factor (CRF), corneal-corrected IOP (IOPcc), and Goldmann equivalent IOP (IOPg). A drop of travoprost 0.004% was applied once daily in right eyes for 3 months; left eyes received no treatments. After 3 months of treatment both eyes of all rabbits were again measured 3 times. After complete keratectomy of both eyes, tissues prepared with hematoxylin-eosin stain were analyzed by means of light microscopy. RESULTS: The mean pre- and post-treatment IOPg, respectively, for right eyes was 9.92 ± 5.64 mm Hg and 7.62 ± 2.99 mm Hg (P = 0.027); IOPcc, 19.81 ± 5.25 mm Hg and 17.79 ± 4.09 mm Hg (P = 0.063); CRF, 1.65 ± 1.63 mm Hg and 2.18 ± 2.50 mm Hg (P = 0.266); and CH, 2.79 ± 1.74 mm Hg and 2.64 ± 2.08 mm Hg (P = 0.72). Mean post-treatment right and left eye IOPg values were, respectively, 7.62 ± 2.99 and 10.30 ± 4.40 (P = 0.002); IOPcc, 17.79 ± 4.09 mm Hg and 20.37 ± 4.32 mm Hg (P = 0.009); CRF, 1.65 ± 1.63 mm Hg and 2.17 ± 2.47 mm Hg (P = 0.274); and CH, 2.79 ± 1.74 mm Hg and 2.54 ± 2.08 mm Hg (P = 0.575). No difference in CH and CRF was observed between treated and untreated eyes. CONCLUSIONS: Post-treatment reduction of IOP in treated eyes was a direct hypotensive effect of travoprost 0.004% and was not affected by changes in corneal biomechanical properties (CH and CRF), resulting in real lower IOP values.

Autodeterminación en personas con discapacidad intelectual que envejecen y algunas variables que inciden en su desarrollo / Self-determination in people with intellectual disabilities who age and some variables that affect their development

Resumen La autodeterminación es un constructo clave para garantizar el desarrollo de habilidades que permitan a las personas con discapacidad intelectual adquirir el control sobre sus vidas. Este estudio busca conocer los niveles de autodeterminación de 516 adultos con discapacidad intelectual en proceso de envejecimiento y algunas variables que inciden en su desarrollo. Desde un enfoque cuantitativo, los datos se han recopilado con una escala ad hoc elaborada desde el modelo funcional de autodeterminación. Las evidencias se han analizado mediante estadísticos descriptivos e inferenciales. Los niveles de autodeterminación de la mayoría de los participantes se sitúan en un rango bajo. Los principales resultados muestran cómo el desarrollo de competencias relacionadas con la autodefensa o el autoconocimiento está muy descendido a diferencia de otras habilidades como la realización de elecciones o la resolución de problemas. Además, la severidad de la discapacidad, la edad, el lugar de residencia o el tipo de apoyo se identifican como factores incidentes en el logro de la autodeterminación. La discusión revela, entre otras, la necesidad de priorizar el aprendizaje de competencias relacionadas con la autorrealización como fundamento de las propuestas de intervención en autodeterminación. Este estudio contribuye a enriquecer el grueso de investigaciones sobre autodeterminación en la adultez tardía, siendo este un aspecto apenas abordado en la literatura. Además, complementa los resultados de otras investigaciones con respecto a los factores que pueden condicionar el desarrollo de estas habilidades. Esto permite ir diseñando intervenciones que propicien oportunidades para trabajar la autodeterminación desde las necesidades sentidas de estas personas.

Abstract Self-determination is a key construct to guarantee the development of skills that enable people with disabilities to acquire control over their lives. This concept is understood as a set of volitional actions or abilities that help the person to act as the primary causal agent in their own life without unnecessary external influences. Progressively, this construct has been shaped as a personal disposition to exercise control over one's own behavior, becoming a priority educational goal and an indicator of quality of life in the field of intellectual disability. However, people with intellectual disabilities have premature aging processes generally accompanied by mental health disorders or emotional problems that hinder the performance of self-determination skills. Specifically, they have difficulties in developing actions aimed at promoting positive attributions of effectiveness or aimed at establishing personal goals. This complicates the acquisition of skills for self-regulation and the increase of personal empowerment skills. This study seeks to know the self-determination levels of 516 aging adults with intellectual disabilities aged between 45 and 86 years (. = 68.32; S = 4.95). Most of them live in the Metropolitan Region (Chile), have severe intellectual disabilities, are men and live with the family. From a quantitative approach and under an inclusive research model, the data have been collected using an ad hoc scale as a result of the revision of the ARC-INICO Self-determination Assessment Scale (Verdugo et al., 2015) and the Self-determination Scale ARC staff (Wehmeyer, 1995). The results have been analyzed using descriptive and inferential statistics that have preceded the use of parametric statistics. The self-determination levels of the majority of the participants (39.1 %) are in a low range. In addition, the development of competencies related to self-defense or self-knowledge are greatly diminished, unlike other skills such as making choices or solving problems. Likewise, the analysis shows how those participants who reside in the family home present higher averages in their self-determination than those who live outside the family home. Similarly, participants with mental health disorders have lower averages in their self-determination than those who do not present these pathologies. Regarding the degree of disability, the levels of self-determination of the mild group are higher than those of the group of adults with severe intellectual disability. Those who most often have family support have higher levels of self-determination than those who receive only professional support. With regard to age, the youngest participants have higher averages than the rest in terms of their self-determination. The discussion highlights, among others, the need to prioritize the learning of skills related to self-realization as the basis of the proposals for intervention in self-determination at this stage of life. The results suggest some implications to consider for the planning of interventions, for example, they should seek the development of skills that strengthen the self-defense capacity of people with intellectual disabilities, promote the increase of opportunities for the realization of meaningful choices, adapt to the scenarios in which aging people with intellectual disabilities usually operate, and involve families and professionals to achieve skills related to self-determination in old age. Despite the fact that one of the main limitations of this research is that the results are not generalizable, this study contributes to enriching the bulk of research on self-determination in late adulthood, this being an aspect barely addressed in the literature. In addition, it suggests the development of future lines of research related to the impact of technological supports on the quality of life of people with intellectual disabilities who age or with the study of cognitive impairment or the presence of mental health disorders in the levels of self-determination of these people.

Achieving Target Pressures with Combined Surgery: Primary Patchless Ahmed Valve Combined with Phacoemulsification vs Primary Phacotrabeculectomy.

PURPOSE: To evaluate the ability of phacoemulsification combined with either primary trabeculectomy (PT) or primary Ahmed glaucoma valve implantation (PAVI) to achieve target intraocular pressures (TIOP) in adults with primary open angle glaucoma. MATERIALS AND METHODS: Chart review of 214 adult patients operated between January 2002 and June 2008 with a minimum follow-up of 6 months. Group 1 comprised 181 eyes of 166 patients undergoing PT while group 2 included 50 eyes of 49 patients in combination with primary AVI. Target lOPs were pre-determined for each patient and success was defined as an IOP at or lower than target with or without medications. An IOP above target, loss of light perception or need for additional procedures to lower IOP were considered a failure. RESULTS: Mean preoperative IOP was 17.2 mm Hg in group 1 and 17.3 in group 2. Mean postoperative IOPs were 10.2 and 9.2 on day 1, 12.2 and 11.6 at year 1, and 10.7 in both groups at year 5. Survival rates in groups 1 and 2 were 96.7 vs 96% at 6 months, 89 vs 96% at 12 months, 83.5 vs 96% at 24 months and 79.4 vs 89.1% at 36, 48 and 72 months. Transient bleb leaks were more frequent in group 1 (26 eyes, 14.4 vs 0%, p = 0.001) and transient choroidal detachments were more frequent in group 2 (7 eyes, 3.9 vs 6 eyes, 12%, p = 0.038). CONCLUSION: Midterm results for achieving target pressures using combined phacoemulsification with either PT or PAVI are comparable. The profile of complications is different for the two procedures. How to cite this article: Albis-Donado O, Sánchez-Noguera CC, Cárdenas-Gómez L, Castañeda-Diez R, Thomas R, Gil-Carrasco F. Achieving Target Pressures with Combined Surgery: Primary Patchless Ahmed Valve Combined with Phacoemulsification vs Primary Phacotrabeculectomy. J Curr Glaucoma Pract 2015;9(1):6-11.